RT Journal Article SR Electronic T1 Sinus bradycardia with haemodynamic compromise following lithium intoxication JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e242946 DO 10.1136/bcr-2021-242946 VO 14 IS 5 A1 Garrett Michael Snipes A1 Adam Hafeez A1 George Marek A1 David E Winchester YR 2021 UL http://casereports.bmj.com/content/14/5/e242946.abstract AB Lithium is a well-established treatment for mood disorders and considered first-line pharmacological therapy for bipolar disorder as per the American Psychiatric Association guidelines. However, lithium is associated with significant toxicity. Cardiotoxicity including sinus node dysfunction is a rare but clinically significant presentation of lithium intoxication. This case report describes an adult male presenting with unstable sinus bradycardia in the setting of acute kidney injury and elevated serum lithium levels. The patient required temporary management with inotropic support and transcutaneous pacing. The patient’s heart rate and hypotension improved in parallel with resolution of his acute kidney injury and elevated serum lithium level after treatment with intravenous fluids. Given the prevalence of bradycardia in both the outpatient and inpatient settings, a high index of suspicion is necessary for the prevention and identification of this clinical entity to guide appropriate management.